Transcript CULTURAL CARE ASSESSMENT FOR CONGRUENT

Nur 471: Socio-cultural Variation in Health
Contemporary Challenges in
Transcultural Nursing
TRANSCULTURAL ASPECTS OF
PAIN
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Objectives
After successful completion of this course,
participants will be able to:
1- Define pain and describe various pain types.
2- Identify Cultural Issues affecting pain
3- To discuss ,Race, Ethnicity, and the Treatment
of Pain
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Definition
 “Pain is whatever the experiencing person says it is,
existing whenever he says it does.”
McCafery (1979)
 Pain is a universal affliction that affects all of us
at some point in our lives. Practically all
hospitalized patients experience pain at some point
during their stay.
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Definition ………………cont
 an unpleasant sensory and emotional experience arising
from actual or potential tissue damage or described in
terms of such damage.
U.S. Department of Health and
Human Services, 1992
1. An unpleasant feeling caused by injury or disease of
the body.
2. Mental suffering.
3. [old use] punishment e.g. on pain of death
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Defintion ……….cont
 In Greek, the word used most often for physical
pain is (algos), which derives from roots indicating
neglect of love.
 Another Greek word is (akos) meaning 'psychic
pain' from which we derive the English 'ache
 Implicit in these meanings is a broader definition
of pain than the narrowly defined
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Defintion ……….cont
Definitions of pain are diverse because of its complex
nature and because of the many different existing
perspectives on pain.
 Pain is a universally recognized phenomenon and
the most frequent compelling reason for seeking health
care.
 Pain is a very private experience and is influenced by
cultural heritage.
 Thus, expectations, manifestations and management of
pain are embedded in a cultural context. Therefore,
understanding culture is critical when dealing with clients
in pain
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Defintion ……….cont
The experience of pain is determined by the:
 meaning of painful stimuli for individuals;
 way individuals define their situation; and,
 impact of previous personal experiences help
determine the experience of pain.
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Cultural Issues
 People from different cultures experience pain
largely based on their meaning of pain.
 Be aware of your own cultural uniqueness and seek to
accept the distinct perspectives of others.
 It is often difficult for you to be knowledgeable
about all of the possible cultural norms of patients.
However, you can be alert to the patient’s verbal and
non-verbal cues
 A careful approach to the patient in these instances
will often set the stage for successful pain
management
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Pain as a Biopsychosocial Phenomenon
Research on the biology and neurobiology of
pain has given us new ways to think about
and manage pain, and is paralleled by
research into the cultural, psychological,
and social factors related to the
experience of pain and its expression,
behavioral responses, health care seeking,
and receptivity to and adherence to
treatment.
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Race, Ethnicity, and the Treatment of Pain
 Race has been an especially important factor
in the experience and treatment of pain
 culture of individual rights that ultimately
included the right to health and health care,
and most recently, pain care.
 racial groups varied in their physiological
experiences to pain, with women, whites, and
the rich being more sensitive to pain than
African Americans, criminals, and Native
Americans,
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Cont.
Pain behavior, or in staff perception and treatment
of patients’ pain.
Recent evidence suggests that the most important
variable in the under treatment of minority
pain may be differences in staff perception of
patients’ pain intensity which may be based on
myth lack of empathy stigma, or outright
discrimination.
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Several factors affect how closely an
individual identifies with his or her ethnic or
cultural group ……… These include
1.
2.
3.
4.
5.
6.
7.
8.
gender,
age,
generation,
level of acculturation,
socioeconomic status (including income, occupation, and
education),
level of ties to the mother country,
primary language spoken at home,
degree of isolation of the individual, and residence in
neighborhoods made up of one’s ethnic group.
These factors may mediate the relationship between ethnic
background and pain.
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Narrative, Culture, and Pain
culture of pain and culture in pain.
The culture of pain describes the ways in
which society shapes the meaning and
treatment of pain.
culture in pain addresses the ways in
which culture molds individuals’
perception and expression of pain, and
their coping response,
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JCAHO Standards
Recognize rights of patients in appropriate pain
assessment and management.
􀀹 Screen for the presence and assess the nature
and intensity of pain in ALL patients.
􀀹 Record the results of assessment in a way that
facilitates regular reassessment of the pain.
􀀹 Determine and ensure staff competency in pain
assessment and management and address
assessment and management of pain in all new
clinical staff.
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Establish policies and procedures that
support the prescribing and ordering of
pain medications.
 Ensure pain does not interfere with a
patient’s rehabilitation.
 Educate patients and families about the
importance of effective pain management
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Cont,
Address patient’s need for symptom
management in the discharge planning
process.
􀀹 Incorporate pain management into
performance review activities (i.e.
establish a means of collecting data to
monitor the appropriateness and
effectiveness of pain management).
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Measurement of Pain
 In terms of pain measurement, it is generally
believed that humans normally experience similar
pain thresholds. Research suggests that there are
no differences in the amount of stimulation
needed to produce a detectable sensation.
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The pneumonic, PQRST
Radiation: Does the pain radiate to another body part?
Quality: Describe the pain. Is it burning, shooting,
aching, stabbing, crushing, etc?
Provocative or Palliative: What makes the pain better or
worse?
Severity: On a scale of 0-10, (10 being the worst) how
bad is your pain? (may use other scales also)
Timing: Does it occur in association with something else?
(i.e. eating, exertion, movement)
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Measurement of Pain … … cont,
Measurement of pain would differ in pain threshold, pain
tolerance
 Pain Threshold – refers to the point at which the
individual reports that a stimulus is painful. For example,
some people required higher intensities before describing
the stimuli as painful.
 Pain Tolerance – is the point at which the individual
withdraws or asks to have the stimulus stopped. Cultural
background appears to have a strong influence on pain
tolerance levels.

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Therapeutic approaches to chronic pain
Somatic-Technical
Pain = organic, time is the only
distinction made between acute and
chronic.
Treatment=surgical procedures to
eradicate, block or ease pain, longterm use of narcotics
Cured = disappearance of symptoms
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Cont.
2.Dualistic Body-Orientated
Pain= mix organic, psychological and
social factors.
Treatment= supposedly no distinction
between body and mind, focus on
nociceptive (i.e. the purely sensory)
Cure= pain is gone.
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Cont.
Behaviorists
Pain= chronic, intractable, ‘pain
behaviour separate from acute pain.
Treatment= behaviour management
Cure=pain behaviour replaced by
effective ‘ well behaviour
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Cont.
Phenomenological
Pain= complex of reactions and
behaviours, result of an interrupted
healing process, pain sufferer is unable
to find a place in the world.
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Cont.
5.Consciousness
Pain=incorporated into the meaning of being human’
Therapy= unspecific, may be any form of treatment
but preferably not invasive surgery
Recovery=by pain disappearing or by gaining enough
insight to accept and manage it
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What Clients Need to Know
Among the skills they need to learn are to:
control stress
develop self-control
stop external control of others or by others
seek help for problems
develop new behaviors
stop isolation
set goals
have fun without an altered state or guilt
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Expressions of Pain,
 Expressions of pain vary from culture to culture. What are
appropriate verbal behavior and body language in response
to pain are dictated by culture. Example: the Japanese
culture does not approve of loud verbal expressions of pain.
 Within each culture, expressions of pain may vary from
person to person. How people express their pain is strongly
influenced by their level of assimilation and acculturation.
 In relation to gender – men demonstrate greater stoicism
than women. However, stoicism decreases with increasing
age. (Zatzick & Dimsdale, 1990)
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Transcultural Food behaviors
Why … … …. …
 Survival
 Sense of belonging
 Self realization
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How … … … …
 Regarding etiquette, meal and sank patterns,
acceptable food, food combinations, proper
sizes
 Etiquette refers to acceptable behavior
 Etiquette and eating rituals also vary depending
on weather the meal is formal, informal or
special
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What …… … …
Any thing that moved can be eaten ?
What are the influence of food choice ?
Cultural , social, religious, economic ,
environmental, political influences
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Cross cultural etiquette
Seating
Eating
Body language
Conversation
Food
Home / restaurant
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Universal functions and uses of foods
 Food for biophysical needs: to provide essential
nutritional needs to help people maintain body
functions and energy and survive. If infants and
adults do not get sufficient basic food nutrients,
signs of nutritional deficiencies, illnesses, inability
to function, and even death occur. E.g. kwashiorkor
,caused by a protein-scarce diet.
 every culture over time has developed what they
believe are essential and preferred foods in their
diet and also have patterned ways to prepare
foods for children and adults.
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

foods for human relationships: in establishing and
maintaining social and cultural relationships with
friends, kinfolk, strangers, and others . food is a
symbol to indicate special social and cultural
patterns and to test or maintain relation ships.
E.g. a ritual beverage break often serve as more
than a nourishment or rest break.
Food has, a universal functions in all ceremonies
and cultures for prestige, to exchange wealth, and
to renew bonds of friendship, solidarity, and
religious functions.
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
Food to assess interpersonal distance:
to assess social relationships or interpersonal
closeness or distance between people. Trans
culturally and universally food use often reflects
the social stratification of society and indicates
which persons are to be respected or held in
positions of higher authority or status.
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 Food to cope with stress and conflict;
using food for coping with emotional stress
conflicts, and traumatic life events.
 Canadians, and Australians often rely on
eating to relieve their stresses and in ways
they may not be fully aware of until weight
gain occur.
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 Food for rewards and punishment: rewarding
children for good behavior are often by some
kind of sweet.
 Food to influence status: universal function
of food is to influence the political and
economic status of an individual or group.
Serving food before, during, and after
political meetings often leads to friendly and
congenital outcome. Foods tends to soften
political group behavior and ease questionable
relationships.
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 Foods to treat and prevent illness: in many
cultures food remains important to prevent
and cure certain illnesses such as
hypertension, D/M, peptic ulcers, coronary
diseases, aging, and other conditions or
disorders.
 Generic food theories and uses: the hot and
cold theory in non western countries and in
ancient Greece with the desire to balance
body fluids or humors between perceived hot
and cold substances .
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 Cultural preferences: eating culturally desired
foods can lead to a quicker recovery from illness
and greater client satisfaction than when these
clients are expected to eat strange or taboo food.
Today , hospital staff need to be educated about
cultural food likes and dislikes through in-service
education and academic courses on Transcultural
nutrition and health care.
 Environmental influences: nurse knowledge about
the peoples environment with an understanding of
what foods are raised or available is important as
one counsels clients about food resources and uses.
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